PHILADELPHIA — Health Commissioner, Dr. Thomas Farley, declared that the ongoing outbreak of Hepatitis A in Philadelphia is a public health emergency and has directed health care providers and governmental and non-governmental agencies to help vaccinate those most at risk for the infection in order to stop the outbreak. As part of the Philadelphia Resilience Project, the City of Philadelphia will be expanding its own outreach to vaccinate homeless persons and others at greatest risk.
Hepatitis Type A is an infection of the liver caused by a virus that is spread by the fecal-oral route, either through personal contact or consumption of contaminated food or water. While most people with the infection recover without special treatment, the disease is particularly dangerous for older people and those with underlying liver disease. Those at the highest risk of contracting Hepatitis A include: people who use drugs, people experiencing homelessness, men who have sex with men, and people who are currently or were recently incarcerated.
There is a very effective vaccine against Hepatitis A, which is now given routinely to children, but most adults have not been vaccinated against the disease. Due to the vaccine, the number of cases of Hepatitis A reported to the Centers for Disease Control and Prevention in the U.S. fell to fewer than 2,000 cases per year. This was a 95% drop from before the vaccine was made readily available. However, in recent years, cities and states around the nation have seen outbreaks of the infection in homeless populations and opioid users. Hepatitis A outbreaks are currently being tracked by the Centers for Disease Control in 24 states, including Pennsylvania.
Philadelphia typically sees between two and six cases of Hepatitis A per year. Since January 2019, the Health Department has been notified of 154 cases. In response to a growing number of Hepatitis A cases, the Health Department has been working with nonprofit and health care organizations and City agencies to vaccinate those in at-risk populations. Since July 2018, the Health Department has coordinated the vaccination of 1,775 people considered at-risk, and reports that more than 12,439 total Hepatitis A vaccinations have been given in the city. Because these efforts have not been sufficient to end the outbreak, the Health Department is mobilizing with this declaration of emergency to vaccinate tens of thousands of additional at-risk folks.
Dr. Farley said, “We don’t want anyone to contract Hepatitis A, and we have the ability to stop this outbreak. Now that we have a safe and effective vaccine, the most important action we can take is for everyone at high risk to be vaccinated. That means that we need help from health care providers and others who see these persons to offer the vaccine to them.”
The public health emergency declaration calls on health care providers and governmental and non-governmental organizations throughout the city to start administering Hepatitis A vaccine to those in the at-risk groups, and their close contacts, immediately and at the first opportunity. People who have been diagnosed with Hepatitis A should take steps to prevent transmission, including hand washing, avoiding food preparation for others, condom use, and drug use harm reduction practices. The public is advised to ensure that they take efforts to protect themselves from Hepatitis A, and other communicable diseases, by washing their hands before eating, using condoms, and talking to their regular health care provider about vaccines. As part of the Philadelphia Resilience Project, city agencies will also try to improve hygiene in the areas with the highest concentration of drug-related homelessness by installing public toilets and handwashing stations.
For more information, the Health Department has developed a fact sheet on Hepatitis A for printing and distribution. A webpage with basic information about Hepatitis A has also been published. The full declaration is appended to this release and is available on the Health Department’s website.
CITY OF PHILADELPHIA
DEPARTMENT OF PUBLIC HEALTH
Office of the Health Commissioner
LOCAL PUBLIC HEALTH EMERGENCY DECLARATION
WHEREAS, Hepatitis A infection is a highly contagious liver disease caused by a virus that is transmitted by the fecal-oral route, either through personal contact or consumption of contaminated food or water, and is particularly hazardous for older individuals and those with underlying liver disease; and
WHEREAS, there are proven interventions to prevent and control transmission of Hepatitis A, including a safe and effective vaccine and improved sanitation; and
WHEREAS, a recent Hepatitis A epidemic in San Diego County, California occurred in 2017 and resulted in 592 reported infections and 20 deaths, primarily affecting people using illicit drugs and people experiencing homelessness, which was eventually controlled through increased vaccination and improved sanitation; and
WHEREAS, thus far in 2019, the Philadelphia Department of Public Health (the “Department”), Division of Disease Control, has confirmed 154 reports of acute Hepatitis A disease compared to an expected 3 reports as observed between January and July from 2013 to 2017; and
WHEREAS, the vast majority of the 2019 cases of Hepatitis A in Philadelphia have occurred since May (85%), where preliminary investigations indicate high proportions among adults who report using drugs (67%), or report experiencing homelessness (26%), provided that these risk factors are expected to increase as more investigations are completed; and
WHEREAS, increased reports of Hepatitis A are occurring in Southern New Jersey and Philadelphia’s suburban counties in Pennsylvania among at-risk populations, thus increasing the risk for more cases in Philadelphia; and
WHEREAS, since the summer of 2018, the Department has conducted extensive outreach to raise awareness and provide Hepatitis A vaccine and personal hygiene items to high-risk populations and potentially exposed persons living in neighborhoods with increased disease burden; and
WHEREAS, the Department has been working with Prevention Point Philadelphia, homeless shelters, hospital emergency departments, the Philadelphia Department of Prisons, and other city agencies who serve at-risk populations to expand outreach, promote vaccination, and increase the Department’s access to these high-risk groups, and has conducted street outreach to interact with these populations; and
WHEREAS, since the summer of 2018, there have been 12,439 reports of adult Hepatitis A vaccinations in the City of Philadelphia for all adults, the Department has administered 1,775 Hepatitis A vaccinations to at-risk people, and the Department has given out over 4,200 items to promote hygiene and education about Hepatitis A to at-risk populations, including hand sanitizer, soap, defecation bags, tissue packets, condoms, and educational pamphlets; and
WHEREAS, despite these aggressive and extensive efforts, Hepatitis A virus is spreading rapidly and is expected to continue doing so, thereby necessitating further action, stronger partnerships and cooperation, and expanded resources to control this epidemic; and
WHEREAS, the Philadelphia Department of Public Health is responsible for enforcing the City of Philadelphia Health Code, including Section 6-205 concerning emergency epidemic control;
NOW, THEREFORE, the Health Commissioner of the City of Philadelphia hereby declares the rapid increase of Hepatitis A infection incidence among at-risk groups a public health emergency, and instructs health care providers, managed care organizations and health insurers, and governmental and non-governmental organizations who treat or work with at-risk groups in Philadelphia to take the following actions to the extent applicable and feasible:
- Vaccinate people at risk, including: persons living homeless, people who use drugs, people who are or were recently incarcerated, men who have sex with men, and people with chronic liver disease with two-dose Hepatitis A vaccine, with the first dose administered at the first opportunity at hospital emergency departments, Federally Qualified Health Centers, primary care and ambulatory health centers, prisons and correctional facilities, and pharmacies; and
- Vaccinate close contacts of cases, including: sex partners, people who share living spaces, people who share drugs, and recent traveling companions who shared living spaces/bathrooms; and
- Reimburse for immunization services provided to health plan members related to this declaration; and
- Advise persons with Hepatitis A to take steps to prevent transmission, including hand washing, avoiding food preparation for others, condom use, and drug use harm reduction practices; and
- Promptly report acute cases of Hepatitis A by calling the Philadelphia Department of Public Health Division of Disease Control at 215-685-6740, or 215-686-4514 outside of business hours.
Date: August 1, 2019
Thomas A. Farley, MD, MPH
City of Philadelphia